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Feasibility study on dietary recommendations for older adults in the European Union Tsz Ning Mak, PhD Workshop JRC Ispra 23-24th October 2014
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Dietary recommendations
• For the purpose of this workshop, the term “dietary
recommendations” is used to represent nutrition or dietary
guidelines/ advice/ guidance, whether nutrient-based or food-
based for older adults in Europe (65 years +), they should:
Have significant contribution to human health, to help maintain cultural
diversity and to optimize nutritional status (prevent malnutrition) in a
sustainable environment (Joint FAO/WHO consultation, 1998)
Be appropriate for the region or country, culturally acceptable and
practical to implement; they should be consistent, easily understood
and easily memorable (EFSA 2010)
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What we know…
Diet has an important role to play in healthy ageing
JRC Science and Policy report
Council conclusions
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Council recognises:
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Council invites the member states to:
#30. Promote policies and initiatives aiming at healthy diet and sufficient
physical activity throughout the lifespan, starting from the earliest stages of life…
and later on during adulthood and older age
#32. Empower citizens and families to make informed choices on diet and
physical activity, providing information for all ages and socio-economic groups,
particularly the most vulnerable such as children, adolescents and elderly…
#41. Support the development and/or implementation of national Food and
Nutrition Action Plans, other actions and policies to address common health
challenges related to unhealthy dietary patterns, obesity, malnutrition and
physical inactivity of EU citizens of all age groups, with a special focus on children and
elderly, and where appropriate the implementation of cost-effective solutions;
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Council invites the member states and the Commission to:
What we want to know…
Are there dietary recommendations targeting older people in Europe?
Partially explored this in the JRC report
• At global level – WHO keeping fit for life (2002)
• At EU level - EFSA scientific opinions
Member states?
• Flaminia Mussio carried out exploratory exercise to identify dietary
recommendations targeting older adults in European countries
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Overview of Dietary Recommendations for Older Adults in the EU28.
Flaminia Mussio 23rd October 2014
DG JRC, Ispra
Disclaimer: This presentation and its contents do not constitute an official position of the European Commission or any of its services. Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of this presentation or its contents
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Background
• Given the importance of diet and nutrition in promoting active and healthy
ageing, are there targeted dietary recommendations for older people in EU28?
Objective
• To describe the current landscape of dietary guidelines/recommendations for
the elderly population across the EU28
• How well are these dietary recommendations translated into targeted
advice/messages for older people?
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
• Search strategy:
• Internet-based exploratory search
• Main focus on National sources: e.g. Ministries & Departments of
Health, Food & Agriculture, country-specific Nutrition Societies,
Institutes for Public Health….
• Search terms:
• Dietary and/or nutritional +
• guidelines and/or recommendations and/or advice +
• older and adults or people
• or elderly +
• 'country'
Methodology
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
• Identification of:
1. (National) dietary recommendations for the elderly population
2. General (National) dietary recommendations for the adult
population
3. NGO/charity recommendations (where 1 & 2 were not
available/identified)
• Differentiation between:
• Nutrient-based guidelines
• Food-based guidelines
• General dietary advice
Methodology
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Findings: (National) dietary recommendations
specific to the elderly and/or included in
(National) guidelines for adults (n=12)
(National) dietary
recommendations not specific
to the elderly (n=7)
No recommendations
identified (n=9)
Belgium Bulgaria Cyprus
Croatia Finland Czech Republic
Denmark Greece Germany
Estonia Hungary Latvia
France Italy Lithuania
Ireland Sweden Luxembourg
Netherlands Austria Malta
Portugal Poland
Romania Slovenia
Slovakia
Spain
UK
(Scotland)2
2 literature review: Older People living in the Community - Nutritional Needs, Barriers and Interventions
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Types of guidelines for the Elderly
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1 1
n=12
Nutrient-based
Food-based
General advice
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Our recently published JRC report on nutrition in active and healthy ageing (AHA)
• Determinants of AHA
• Undernutrition and functional decline
• Key nutrients important for AHA
• Whole diet approach
• Future research directions
https://ec.europa.eu/jrc/sites/default/files/lbna2
6666enn.pdf
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
Nutrients commonly addressed in AHA
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Micronutrients
Percentagerecommendationsaddressing eachmicronutrient
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Energy Prot Fat CHO
Macronutrients
Percentagerecommendations addressing eachMacronutrient
N= 10
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
The French example:
• Addresses nutritional and physical
activity needs of older adults
• Gives practical examples of which foods
should be consumed by providing
explanations, tips, menu suggestions and
recipe ideas
• Emphasis on protein, emphasis on fluid
intake.
How have recommendations been translated into dietary advice for the elderly?
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
The French example
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
USA example3:My Plate for Older Adults
• highlights the nutritional and physical
activity needs of older adults
• gives examples of nutrient-rich foods
• Informs on limiting foods that are high in
TFA and SFA, limiting salt and added
sugars, and eating plenty of whole grains
How have recommendations been translated into dietary advice for the elderly?
3 Tufts University (2011)
Disclaimer: The contents of this presentation are the views of the author and do not necessarily represent an official position of the European Commission.
• 12 recommendations identified across the EU28
• Of these 10 were nutrient-based, 1 food-based and 1 general
advice
• None of the 10 cover all nutrients considered as important for
AHA
Conclusions
What we want to know…
Are there dietary recommendations targeting older people
in Europe?
Partially explored this in the JRC report
• At global level – WHO keep fit for life (2002)
• At EU level - EFSA scientific opinions
Member states?
• Flaminia Mussio carried out exploratory exercise to identify dietary
recommendations targeting older adults in European countries
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Feasibility analysis of dietary recommendations for older adults in Europe
• How We Design Feasibility Studies.
Bowen et al. Am J Prev Med. 2009; 36(5): 452–457.
8 key areas of focus: Acceptability; demand; implementation; practicality; adaptation;
integration; expansion; limited-efficacy testing
• Scientific Opinion on establishing Food-Based Dietary Guidelines
European Food Safety Authority. EFSA Journal 2010; 8(3):1460
Scientific process of developing food-based dietary guidelines (FBDG) for the diverse European
populations, should follow a stepwise approach of 7 steps
• Keep fit for life : Meeting the nutritional needs of older persons.
WHO 2002
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Discussions
Is there a demand for dietary recommendations for older adults?
What are the limitations and/or barriers to introduce or promote
dietary recommendations?
Identify possible strategies to promote better diet to combat
malnutrition
Propose roadmaps to move towards such recommendations
in the EU
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Discussion 1
Is there a demand for dietary recommendations for older adults?
• Is it too late to start at 65y?
• Will they be useful to optimise intake?
• How will they be used?
• Who would be the end users? Older individuals or carers or health
professionals? Free-living vs. institutionalised?
• Is there data to support its use?
• Consensus?
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What are the limitations and/or barriers to introduce or promote
dietary recommendations to specific groups (of older adults)?
• Stratification: we discussed this, how will we stratify/what to stratify?
• How would you introduce or promote dietary recommendations in your
region? What would be the challenges?
• Tip: It may help to develop dietary recommendations applicable to your
region, in doing so think about the process and potential barriers
• Acceptability, implementation, adaptation (existing dietary rec. from neighbouring
countries), food availability/ accessibility
Discussion 2
3 groups
South
Ines
Patrizia
Claudio
Giuseppe
Antonia
Cristina
Petros
Flaminia
Middle
Isabelle
Mojca
Elizabeth A
Monika
Neile
Lisette
Theodora
North
Elisabet R
Susanna
Susanne
Anja
Andrea
Jan
Stefan
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Discussion 3
Can we identify possible strategies to promote better diet for the
elderly?
• Ideas for solutions to overcome limitations/ barriers
• Possible strategies/ activities, interventions to promote better diet
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Welcome to Day 2
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Recap – Discussion 1 (Demand)
• Existing dietary recommendations for healthy adults (except for
some nutrients) are sufficient for the healthy older adult
population.
• There is a demand for DR for specific groups of older adults.
• Specifying these groups is complex, stratification could be
based on age, functional (cognitive and physical) status, frailty,
at risk of malnutrition etc
• Lack of evidence to support that healthy older adults need
different dietary recommendations (except for some)
• Pressing need to stratify age groups, especially older old adults
Public health issue health care issue
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Recap - Discussion 2 (limitations)
• Geriatricians and nutritionists don’t talk to each other
• Nutrition education/ awareness is not part of medical disciplines
• Lack of multidisciplinary approaches
• Well-informed people/ professionals don’t adopt/apply
guidelines
• Lack of participatory approach from all key stakeholders
• Lack of comprehensive detection/ screening process for onset of
malnutrition outside clinical settings
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Recap – Discussion 3 (Strategies)
Strategy 1: Implement comprehensive malnutrition screening
Strategy 2: Develop targeted dietary recommendations
Strategy 3: Implement general screening based on multi-disciplinary teams
Strategy 4:Implement person-centred public health interventions
Additional research
Address contradicting policies
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Votes
Strategy 1: 6 votes
Strategy 2: 12 votes
Strategy 3: 9 votes
Strategy 4: 7 votes
Additional research: 9 votes
Contradictory policies: 3 votes
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Develop roadmaps in discussion
session 4
Discussion 4
Propose roadmaps to move towards strategies to combat
malnutrition in older Europeans
Some ideas for discussion
• Define your objectives
• Who is your target audience?
• Where will you implement your strategy? Which level? What setting?
• What's the budget? who is funding it?
• Do you have evidence to support the need of your proposal? If not,
where/how will you get it?
• Sustainable long term?
• Monitor process and evaluate success?
• Plan B?
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